Individual
KEVIN MARK RICKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1990 INDUSTRIAL BOULEVARD, HOUMA, LA 70363-7055
(985) 868-9300
(985) 851-0053
Mailing address
1990 INDUSTRIAL BOULEVARD, HOUMA, LA 70363-7055
(985) 868-9300
(985) 851-0053
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
A10312RX
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1626759
—
LA
Enumeration date
06/09/2006
Last updated
06/08/2009
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